tbuckley/cabot-search huggingface dataset:
AB1511 SLE ONSET POST COVID-19 VACCINATION: COINCIDENTAL OR ASSOCIATION?
Authors: C. R. Ng, C. E. Goh
Journal: Annals of the Rheumatic Diseases (2022)

Background Numerous immune-mediated diseases flare or new disease onset after SARS-CoV2-vaccination have been reported. There were case reports showed the immune-mediated disease flare post vaccination but study on new disease occurs post Covid-19 vaccination is still lacking. Objectives To describe two SLE cases that diagnosed post Covid-19 vaccination. Methods Case report Results 14 years old girl, post Covid-19 vaccination 1 st dose 3 weeks ago presented with 2 day history of giddiness, breathlessness, vomiting and diarrhea prior to admission. She also complained of frothy urine for the past 1 week associated with lower limbs swelling and facial puffiness. Clinical examination noted she had sparse hair, oral ulcers and discoid lupus at the ear concha. She also noted to have periorbital puffiness with pedal edema. Lung auscultation noted bi-basal crepitations. Blood investigation noted ANA positive (1:640, speckled) with low complement 3 (0.1g/L). Her full blood count showed leucopenia (3100 UL) with low lymphocyte count of 810UL. UFEME noted protein of 3 + and red blood cell of 2+ with normal renal profile. Her serum albumin was 22g/L. Chest x ray showed clear lung field with no cardiomegaly. Her 24-hour urine protein showed proteinuria of 2.345g/dl and her renal biopsy showed mesangial proliferative lupus nephritis class ii. She was given intravenous methylprednisolone 500mg OD for 3 days and discharged with tapering dose of prednisolone, hydroxychloroquine, calcium supplements, perindopril and frusemide. Another case was a 17 year-old female, post covid-19 vaccination 10 weeks, presented with 3 weeks history of bilateral lower limbs weakness with difficulty in getting up from chair. She also had fever on and off with cough for 1 week. There was no alopecia, oral ulcer, facial rash or photosensitivity. No joints pain. Clinical examination noted presence of proximal myopathy with stable vital signs. Other systemic examinations were unremarkable. Blood investigation noted ANA positive (1: 640, homogenous and speckled) with low complements level (C3 0.19g/L and C4 0.049 g/L).Her creatine kinase was 2367U/L and EMG showed evidence of irritable myopathic process which is consistent with inflammatory myositis. Her TFT was normal. Myositis panel showed anti-Ku and anti-Ro 52 were positive. She was treated as SLE with myositis and intravenous methylprednisolone was given. She discharge well with tapering dose of prednisolone and azathioprine. Her creatine kinase showed improvement with immunosuppression therapy and she was advised on intensive physiotherapy. Conclusion The onset of these two SLE cases were occurred within the 2 month of post covid-19 vaccination. Whether Covid-19 vaccination direct contribute to the occurrence of SLE remained inconclusive. More studies are required to show its correlation between onset of SLE and Covid-19 vaccination. References NIL Disclosure of Interests None declared
AB0908 Treating to target of psoriasis: An evidence-based consensus on clinical practice recommendations
Authors: Y. El Miedany, M. H. Abu-Zaid, M. Elgaafary, N. Ali, M. Mansour, N. Fathi, W. Hassan, M. A. Mortada, S. Moussa, M. Eissa, S. A. A. Tabra, N. Fouad, R. Ali, B. M Medhat, J. Jamaleldeen, Y. Adel Abdelsalam Hussein, R. M. Ghaleb, E. Nourhan Elameen, E. Dessouki, S. Saber
Journal: Annals of the Rheumatic Diseases (2022)

Background The Tight Control of psoriatic arthritis (TICOPA) trial revealed a treat to target (T2T) strategy has led to improved clinical outcomes in psoriatic arthritis (PsA). The heterogeneity of the disease, the feasibility of therapy and the associated comorbidities made the implementation of such strategy in routine care a real challenge. There is a high need for establish real world recommendations for the T2T approach in PsA tailored to the disease activity status, the Psoriasis manifestations as well as the individual patient’s requirements. Objectives to provide up-to-date, evidence-based and consensus-based recommendations for Treat-to-Target management of psoriatic arthritis (PsA) and its associated clinical manifestations. Methods 14 key clinical questions were identified by scientific committee according to the Patient/ Population, Intervention, Comparison, Outcomes and Timing (PICOT) approach. Literature Review team performed a systematic review to summarize evidence advocating the benefits and harms of available pharmacologic and nonpharmacologic therapies for PsA. Subsequently, recommendations were formulated. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A 3-round Delphi process was conducted with 19 experts. All rounds were conducted online. A consensus was achieved on the direction and the strength of the recommendations. Results An online questionnaire were sent to expert panel who participated in the three rounds (response rate 100%). At the end of round 3, a total of fifty-one recommendation items, categorized into 6 sections to address the main 6 PsA categories, were obtained. Agreement with the recommendations (rank 7-9) ranged from 89.5-100%. Consensus was reached (i.e.≥75%of respondents strongly agreed or agreed) on the wording of all the 51 clinical standards identified by the scientific committee. Algorithms for the management of PsA have been suggested. Conclusion These recommendations provide an updated consensus on the pharmacological treatment of PsA and strategies to reach optimal treat to target outcomes in in common clinical scenarios, based on a combination of evidence and expert opinion. Best treatment decisions should be tailored to each individual patient situation. Disclosure of Interests None declared
Single-cell transcriptomic analysis identifies an immune-prone population in erythroid precursors during human ontogenesis
Authors: Changlu Xu, Jian He, Hongtao Wang, Yingnan Zhang, Jing Wu, Lu Zhao, Yue Li, Jie Gao, Guangfeng Geng, Bingrui Wang, Xiaoyuan Chen, Zhaofeng Zheng, Biao Shen, Yang Zeng, Zhijie Bai, Hua Yang, Shujuan Shi, Fang Dong, Shihui Ma, Erlie Jiang, Tao Cheng, Yu Lan, Jiaxi Zhou, Bing Liu, Lihong Shi
Journal: Nature Immunology (2022)
POS1358 CLINICAL PRESENTATION AND MANAGEMENT OF IDIOPATHIC GRANULOMATOUS MASTITIS IN A MIDDLE EASTERN POPULATION
Authors: Z. Abdulelah, S. Qurashi, L. El-Asir, S. Alsayed
Journal: Annals of the Rheumatic Diseases (2022)

Background Idiopathic Granulomatous mastitis (IGM) is a rare inflammatory disease of the breast with poorly understood aetiology or risk factors. IGM has a predilection towards women of child-bearing age with a history of breastfeeding, particularly among Hispanic and Asian ethnicities. However, the true prevalence is unknown with IGM being poorly studied in Middle Eastern Arab and Levantine women who have different genetic, epidemiological, and environmental characteristics. Objectives To study the clinical features of Middle Eastern women diagnosed with biopsy-confirmed IGM. Methods A retrospective observational study of patients with a biopsy-confirmed diagnosis of IGM, referred to two different private outpatient rheumatology clinics in Amman- Jordan between 2016-2021. The Patients’ characteristics, clinical presentation, treatment, and outcomes were recorded Results A total of 25 patients were identified in this study. The mean age was 34.9 ± 5.2 years. All females presented with a breast nodule and tenderness, while only 16% reported associated skin changes in the breast and 12% reported galactorrhoea. Bilateral breast involvement occurred in only 4 patients (16%) while 21 patients had unilateral breast involvement. Systematic manifestations including myalgia/arthralgia, skin changes, fever, and axillary lymphadenopathy were reported by 44%, 16%, 20%, and 16% of patients, respectively. Notably, all enrolled females were married at the time of presentation and 3 of them were pregnant or postpartum during the onset of symptoms. The majority of patients (n= 21, 84%) had a prolonged period of breastfeeding (&gt; 6 months). Moreover, 80% of patients had ≥3 pregnancies with 60% having their youngest child aged 3-5 years. 20 patients (80%) had a complete resolution of symptoms, and 20% (n=6) were lost to follow-up. Among patients who completed follow-up, treatment duration lasted for ≥ 1 year in 36% (n=9) of patients, whereas 11 patients had a complete resolution in less than a year. Azathioprine, methotrexate, antibiotics, and steroids were used in the treatment of 20%,36%, 60%, and 68%, respectively. Of note, only 1 patient underwent surgical intervention during treatment. Conclusion Many theories had suggested different aetiology for IGM but, in our cohort, it appears that being multiparous and prolonged breastfeeding carry higher risks of developing granulomatous mastitis. Although the aetiology is unclear, early diagnosis and the introduction of treatment using steroid therapy and immunosuppression can improve prognosis and prevent unnecessary surgery. Most of our patients that were treated with corticosteroid, Azathioprine, and Methotrexate had a complete resolution of symptoms after one year of therapy. Disclosure of Interests None declared
AB1175 EFFECTS OF THE COVID-19 DISEASE ON AXIAL SPONDYLOARTHRITIS DISEASE FLARE
Authors: B. Armagan, E. Atalar, B. Özdemir, Ö. Karakaş, E. Kayacan Erdogan, S. C. Güven, I. Dogan, O. Küçükşahin, A. Erden
Journal: Annals of the Rheumatic Diseases (2022)

Background Rheumatological disease flares may be seen after many infections. However, our knowledge for the post-COVID axial spondyloarthritis (SpA) flares and its related factors is limited. Objectives We aimed to evaluate disease activity and factors that may be associated with disease activity in axial SpA patients in post-COVID period. Methods We retrospectively assessed the axial SpA patients who have had COVID-19 disease confirmed by a positive SARS-CoV-2 polymerized chain reaction (PCR) test result. Demographics, comorbid diseases, active medical treatments for SpA and information regarding COVID-19 clinical courses were collected from medical records. PCR positive patients were reached via telephone and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scored for pre- and post-COVID SpA symptoms. An increase of ≥2 points in the BASDAI score was defined as flare, and SpA groups with and without flare were compared. Factors predicting SpA flare were also analyzed by the logistic regression analysis. Results A total of 48 axial SpA patients were included in our study, 65% of them male and the mean±SD age was 42.3±8.6 years. Post-COVID SpA flare was seen in 38% patients. Demographic, clinical, medical features of the SpA patients and COVID-19 disease severity were similar between Flare and No flare groups. In comparison of the COVID-19 symptoms, although most of the COVID-19 related symptoms were similar between two groups, the frequency of the back pain and diarrhea were higher in the Flare group than No flare group. But in multivariate analysis, only history of the inflammatory bowel disease had an increased risk for post-COVID SpA flare (Table 1). Table 1. Results from adjusted logistic regression model of the spondyloarthritis flare Variables Enter Method Backward:Conditional Method OR 95% CI p OR 95% CI p Smoking 0.125 0.013-1.233 0.075 Multimorbidity 0.244 0.047-1.256 0.091 Inflammatory bowel disease 33.221 1.236-892.720 0.037 34.382 1.571-752.462 0.025 Fever 1.582 0.334-7.486 0.563 Arthralgia 3.438 0.233-50.630 0.368 Back pain 1.054 0.080-13.895 0.968 OR: Odds ratio, CI: Confidence Interval Conclusion The presence of inflammatory bowel disease statistically significant related post-COVID SpA flares. In addition, diarrhea and back pain symptoms in COVID-19 disease may be stimulating factors for SpA flares but we found no effect of rheumatological therapies. Disclosure of Interests None declared
POS0571 THE ROLE OF PROINFLAMMATORY CYTOKINES (IL-6 AND IL-17) IN PREDICTING 6-YEAR RESULTS OF EARLY RA THERAPY
Authors: V. Rybakova, A. Avdeeva, E. Nasonov
Journal: Annals of the Rheumatic Diseases (2022)

Objectives To evaluate the dynamics of indicators of the cytokine profile and determine their role in predicting long-term results of early rheumatoid arthritis (RA) therapy. Methods The research included 93 patients with early RA (16 men and 77 women), average age Me;IQR (58 [49; 66] years), the duration of the disease 7 [4-11,5] months, DAS28-ESR high 59.7% and moderate activity 38.8%. All patients were prescribed a subcutaneous form of methotrexate (MT) at an initial dose of 10 mg / week with a rapid escalation of the dose to 20-30 mg / week. If the effectiveness of the therapy was insufficient, biologics were prescribed. The concentration of 27 cytokines in the blood serum: IL-1b, IL-1Pa, IL-2,-4,-5,-6,-7,-8,-9,-10,-12,-13,-15,-17, Eotaxin, FGF-basic, IFN-γ, IP-10, MCP-1, MIP-1α, MIP-1β, RANTES, TNF-α, VEGF (pg/ml) were determined with the help of the multiplex xMAR technology on the Bio-Plex array system analyzer (BIORAD, USA). Results Before the start of the therapy, the DAS 28-ESR was 5.31 [4.79; 6.14], SDAI – 28.27 [18.79; 40.73], after 6 years, the DAS28-ESR was 4.0 [3.4; 4.59], SDAI - 15.06 [9.32; 21]; remission of the disease: DAS 28-ESR was detected in 7.8%, SDAI-5.3%; the low activity: DAS28-ESR in 21%, SDAI in 30.1 %, moderate activity: 60% according to DAS28-ESR, 56% according to SDAI, high activity: 11.2% according to DAS28-ESR, 8.6% according to SDAI. Prior to the start of therapy, the group of patients with RA had a higher level of pro-inflammatory cytokines (IL -6, IL -12, IL -15, IL -17), anti-inflammatory (IL -5, IL -13), chemokines (IP- 10, MIP-1ß, IL-8) and growth factors (IL -7, PDGF-BB, VEGF) compared with healthy donors (p&lt;0.05) Table 1. After 6 years, the patients were divided into groups: remission/low activity and moderate/ high activity. Among the patients who achieved remission/low SDAI activity by the 6th year after the initiation of the therapy, a lower level of IL -6, IL -17 after 12 weeks, IL -9 after 24weeks p&lt;0.05 was observed. There was a low level of IP-10 (p=0.06) 12 weeks after the start of therapy. (Table 2) Conclusion The evaluation of the level of proinflammatory cytokines (IL -6, IL -17), chemokines IP-10, immunoregulatory cytokine IL -9 after 12 weeks and 24weeks of the initiation of therapy allows to identify a group with the worst long-term prognosis. Disclosure of Interests None declared.
AB0113 A MINIMAL-INVASIVE METHOD TO RETRIEVE AND IDENTIFY ENTHESEAL TISSUE FROM PSORIATIC ARTHRITIS PATIENTS
Authors: M. G. Raimondo, M. Pachowsky, C. Xu, S. Rauber, K. Tascilar, H. Labinsky, A. Soare, L. Bräuer, J. Rech, D. Simon, A. Kleyer, G. Schett, A. Ramming
Journal: Annals of the Rheumatic Diseases (2022)

Background Enthesitis represents a hallmark feature of spondyloarthritis, including psoriatic arthritis (PsA). 1 So far, most of the data on enthesitis in PsA are based on clinical assessment of tenderness as well as MRI or ultrasound examinations. 2 These approaches, however, do not allow molecular analysis of entheses, which will require acquisition of entheseal tissue. Up today, it is unknown, which entheseal structure in humans would qualify for a feasible biopsy and how correct sampling of entheseal structures could be ascertained within such biopsy material. These technical challenges have led to substantial lack of knowledge on human entheseal tissues. Objectives To establish a minimally invasive biopsy technique of human entheses for the analysis of entheseal tissue in patients with PsA. Methods Human cadavers were used for establishing the technique to retrieve tissue from the lateral humeral epicondyle enthesis (cadaveric biopsies). After biopsy, the entire entheses was surgically resected (cadaveric resections). Biopsies and resections were assessed by label-free second-harmonic-generation (SHG) microscopy. The same biopsy technique was then applied in PsA patients with subsequent definition of entheseal tissue by SHG. Results Entheseal biopsies were performed in five cadavers and allowed the retrieval of entheseal tissue, validated by analysis of the resection material. Thus, microscopy of biopsy and resection sections allowed differentiation of entheseal, tendon and muscle tissue by SHG and definition of specific intensity thresholds for entheseal tissue. The same method was then successfully applied to 10 PsA patients. Hence, the fraction of entheseal tissue within the PsA biopsy specimens was high (65%) and comparable to the fraction retrieved in cadaveric biospies (68%) as assessed by SHG microscopy. Conclusion Entheseal biopsy of the tendon plate of the lateral epicondyle is feasible in PsA patients allowing reliable retrieval of entheseal tissue and its identification by SHG microscopy. References [1]Schett, G, Lories D, D´Agostino MA, Elewaut E, Kirkham B, Soriano ER, McGonagle D. Enthesitis: from pathophysiology to treatment Nat Rev Rheumatol 2017 Nov 21;13(12):731-741. [2]Groves C, Chandramohan M, Chew NS, et al. Clinical Examination, Ultrasound and MRI Imaging of The Painful Elbow in Psoriatic Arthritis and Rheumatoid Arthritis: Which is Better, Ultrasound or MR, for Imaging Enthesitis? Rheumatol Ther 2017;4:71-84. Disclosure of Interests None declared
Explanation for Error in Types of Medicare Patients Included in Aortic Valve Replacement Study
Authors: Mabel Chung
Journal: JAMA Cardiology (2022)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Cardiology HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Cardiology journal
AB0089 INTEGRIN α11β1 DEFICIENCY AFFECTS THE COURSE OF DISEASE IN THE ARTHRITIC hTNFtg MOUSE
Authors: A. De Giuseppe, A. Deichsel, K. Rauwolf, I. Zeinert, N. Lu, D. Beckmann, U. Hansen, D. Kronenberg, D. Gullberg, B. Eckes, T. Pap, A. Korb-Pap
Journal: Annals of the Rheumatic Diseases (2022)

Background Rheumatoid arthritis (RA) is an autoimmune disorder conducted by fibroblast-like synoviocytes (FLS), which acquire a tumor-like phenotype causing irreversible cartilage and bone damage. FLS attache to the extracellular matrix (ECM) invading the joints, a process mediated by integrins. Integrins are transmembrane proteins regulating several cell functions like cell migration, cell proliferation, tissue invasion and cytokine expression – key mechanisms during the pathogenesis of RA. The collagen-binding Integrin α11β1 (α11) is expressed on FLS mediating their adhesion to the ECM and in this study, we analysed its implication in RA. Objectives We examined the pathogenesis of RA in a murine arthritis model (hTNFtg) lacking α11 to analyze its contribution to joint destructions and the disease course. Methods Expression levels of α11 were analysed by Western Blot and immunofluorescence staining using FLS and synovial tissue of patients with RA and hTNFtg mice in comparison to their respective controls. Crossbreeding hTNFtg with α11 deficient ( itga11 -/ - ) mice enabled us to evaluate arthritis progression using clinical parameters like paw swelling and grip strength. Inflammation area and cartilage damage were quantified by histomorphological techniques such as toluidine blue staining of in paraffin-embedded sections from hind paws. Bone erosion was visualized by µCT imaging and quantification of the bone volume in the tarsal bone area. Results High expression levels of α11 could be detected in hTNFtg and human RA samples in comparison to their controls. The progression of arthritis in itga11 -/- hTNFtg was slower and less severe in comparison to hTNFtg mice, visible in a stronger grip strength and reduced paw swelling at the same timepoint. The histomorphology analysis confirmed these results showing higher cartilage area (3.21% vs 5.22%, p &lt; 0.05), less cartilage destruction (51.73% vs 35.65%, p &lt; 0.05) and reduced inflammation (28.28% vs 12.00%) in itga11 -/- hTNFtg compared to the hTNFtg mice. Also, the quantification of the tarsal bone area revealed a higher bone volume (77.94% vs 84.92%, p &lt; 0.01) in itga11 -/- hTNFtg. Conclusion This study showed the important role of α11 in the progression of joint destruction as it is highly expressed in hTNFtg mice and in human synovial tissue of patients with RA. Its absence results in less severe arthritis progression and joint destruction, therefore a possible and interesting target for RA treatment. Disclosure of Interests None declared
Testing for Differences in Survival When Treatment Effects Are Persistent, Decaying, or Delayed
Authors: John O'Quigley
Journal: Journal of Clinical Oncology (2022)

A statistical test for the presence of treatment effects on survival will be based on a null hypothesis (absence of effects) and an alternative (presence of effects). The null is very simply expressed. The most common alternative, also simply expressed, is that of proportional hazards. For this situation, not only do we have a very powerful test in the log-rank test but also the outcome is readily interpreted. However, many modern treatments fall outside this relatively straightforward paradigm and, as such, have attracted attention from statisticians eager to do their best to avoid losing power as well as to maintain interpretability when the alternative hypothesis is less simple. Examples include trials where the treatment effect decays with time, immunotherapy trials where treatment effects may be slow to manifest themselves as well as the so-called crossing hazards problem. We review some of the solutions that have been proposed to deal with these issues. We pay particular attention to the integrated log-rank test and how it can be combined with the log-rank test itself to obtain powerful tests for these more complex situations.